MEDICARE: ERICA FORTINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	MSW011862	GA

General Provider Information

NPI Number	:	1265392062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA FORTINA

Provider Business Mailing Address
First Line	:	3220 OVERLAND DR
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-8905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 POWDER SPRINGS ST
Second Line	:	C-17
City	:	MARIETTA
State	:	GA
Zip	:	30064
Country	:	US
Telephone Number	:	470-502-6310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2025
Last Update Date	:	12/14/2025

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Directions to “ ERICA FORTINA ” Practice Location

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